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Performance status, significant weight loss, and pleural effusion are robust predictors of early mortality (30-, 35-, and 40-day) after palliative radiotherapy for bone metastases, enabling the construction of a risk stratification model. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 3, 2023Open Access

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

CNCarsten NiederNordland Hospital Trust LSLuka StanisavljevićNordland Hospital Trust BMBård MannsåkerNordland Hospital Trust

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Abstract

BACKGROUND: This study analyzed mortality after radiotherapy for bone metastases (287 courses). Endpoints such as treatment in the last month of life and death within 30, 35 and 40 days from start of radiotherapy were evaluated. METHODS: Different baseline parameters including but not limited to blood test results and patterns of metastases were assessed for association with early death. After univariate analyses, multi-nominal logistic regression was employed. RESULTS: Of 287 treatment courses, 42 (15%) took place in the last month of life. Mortality from start of radiotherapy was 13% (30-day), 15% (35-day) and 18% (40-day), respectively. We identified three significant predictors of 30-day mortality (performance status (≤ 50, 60-70, 80-100), weight loss of at least 10% within 6 months (yes/no), pleural effusion (present/absent)) and employed these to construct a predictive model with 5 strata and mortality rates of 0-75%. All predictors of 30-day mortality were also associated with both, 35- and 40-day mortality. CONCLUSION: Early death was not limited to the first 30 days after start of radiotherapy. For different cut-off points, similar predictive factors emerged. A model based on three robust predictors was developed.

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